Khalili T M, Fleshner P R, Hiatt J R, Sokol T P, Manookian C, Tsushima G, Phillips E H
Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Dis Colon Rectum. 1998 Jul;41(7):832-8. doi: 10.1007/BF02235361.
We compared laparoscopic with open colectomy for treatment of colorectal cancer.
We performed a retrospective review of patients undergoing colectomy for colorectal cancer between January 1991 and March 1996 at a large private metropolitan teaching hospital. Operative techniques included open (n=90) and laparoscopic (n=80) colectomy. Laparoscopic colectomy was further subdivided into the following groups: facilitated (n=62), with extracorporeal anastomosis; near-complete (n=9), with small incision for specimen delivery only; complete (n=3), with specimen removal through the rectum; and converted to an open procedure (n=6). Main outcome measures included operative time, blood loss, time to oral intake, length of postoperative hospitalization, morbidity, lymph node yield, recurrence, survival, and costs.
Operative time was equivalent in the laparoscopic and open groups (laparoscopic, 161 minutes; open, 163 minutes; P=0.94). Blood loss was less for the laparoscopic group (laparoscopic, 104 ml; open, 184 ml; P=0.001), and resumption of oral intake was earlier (laparoscopic, 3.9 days; open, 4.9 days; P=0.001), but length of hospitalization was similar. Mean lymph node yield in the laparoscopic group was 12 compared with 16 in the open group (P=0.16). Rates of morbidity, recurrence, and survival were similar in both groups. No port-site recurrences occurred.
Laparoscopic and open colectomy were therapeutically similar for treatment of colorectal cancer in terms of operative time, length of hospitalization, recurrence, and survival rates. The laparoscopic approach was superior in blood loss and resumption of oral intake.
我们比较了腹腔镜结肠切除术和开放结肠切除术治疗结直肠癌的效果。
我们对1991年1月至1996年3月间在一家大型私立都市教学医院接受结肠切除术治疗结直肠癌的患者进行了回顾性研究。手术技术包括开放结肠切除术（n = 90）和腹腔镜结肠切除术（n = 80）。腹腔镜结肠切除术进一步细分为以下几组：简易组（n = 62），采用体外吻合；近完全组（n = 9），仅通过小切口取出标本；完全组（n = 3），通过直肠取出标本；转为开放手术组（n = 6）。主要观察指标包括手术时间、失血量、恢复经口进食时间、术后住院时间、发病率、淋巴结获取数量、复发率、生存率和费用。
腹腔镜组和开放组的手术时间相当（腹腔镜组为161分钟，开放组为163分钟；P = 0.94）。腹腔镜组的失血量较少（腹腔镜组为104毫升，开放组为184毫升；P = 0.001），恢复经口进食更早（腹腔镜组为3.9天，开放组为4.9天；P = 0.001），但住院时间相似。腹腔镜组平均获取的淋巴结数量为12个，开放组为16个（P = 0.16）。两组的发病率、复发率和生存率相似。未发生切口部位复发。
就手术时间、住院时间、复发率和生存率而言，腹腔镜结肠切除术和开放结肠切除术在治疗结直肠癌方面疗效相似。腹腔镜手术在失血量和恢复经口进食方面更具优势。
